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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004361
Report Date: 04/01/2022
Date Signed: 04/01/2022 10:20:58 AM

Document Has Been Signed on 04/01/2022 10:20 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:PROGRESSIVE COMMUNITY & VOCATIONAL SERVICESFACILITY NUMBER:
306004361
ADMINISTRATOR:YURIDIA LUNAFACILITY TYPE:
775
ADDRESS:2034 PLACENTIA AVENUETELEPHONE:
(949) 548-0744
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 75CENSUS: 68DATE:
04/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:Yurida Luna - Administrator TIME COMPLETED:
10:32 AM
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Licensing Program Analysts (LPAs) Sean Haddad and Andrea Mendivil conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPAs were greeted and granted entry into the facility by Administrator Yurida Luna and explained the reason for the visit.

At 9:15am LPAs toured the facility with Yurida Luna Administrator. Facility has 17 clients and 14 staff present during today's visit. LPAs observed clients engaged in activities in the facility. Facility appears clean and sanitary. LPAs observed the screening/ sanitizing station in the entrance of the facility. Facility uses a handwritten sign in/ questionnaire. Facility takes client and staff temperatures daily and documents. Facility has covid precaution postings, The facility mitigation plan has been completed and approved. First aid kit contained all required items. LPAs observed locked toxins. Fire extinguishers are mounted and charged. LPAs observed the posted activity schedule including exercise, puzzles, and movies. Facility has a plan for covid testing clients and staff as needed as well as a plan for isolation. LPAs observed an ample supply of PPE. All staff and some clients are vaccinated for Covid-19. LPAs reviewed some client files and all contained required documentation including updated emergency information.


No deficiencies noted during today's visit. Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE: DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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